Involving Nurses in Hospital Staffing Decision-Making

A qualitative study that looks at the experiences of nurses who have served on staffing committees.

When I am faced with challenging situations and issues that involve multiple stakeholders, I seek guidance or information from others to make the most informed decisions. This is a practice many health professionals and researchers emulate, and it makes sense to do this, yet when it comes to the topic of nurse staffing in hospital settings, nurses are not usually involved in the process. If they are involved to some degree, it is likely because of a hospital’s pursuit for nursing excellence recognition through shared governance and/or the external pressure of state laws, like mandated nurse staffing committees.

Nurse autonomy and engagement means better care.

Over the years, research has shown how increases in nurse autonomy and engagement can positively benefit patient care and support nurse retention, yet how do these concepts apply to nurse staffing? In what ways are those concepts translated into practice or policy efforts? These were the questions that initially guided me.

Seeking a real voice in nurse staffing policymaking.

In a survey exploring the concept of staff nurse involvement in hospital staffing policymaking, most nurses described feeling powerless. with little to no meaningful opportunities to be involved in staffing decision-making.

Yet nurses expressed a desire for involvement, both for their own sake and that of their patients and the systems they worked in. Nurses mentioned opportunities for involvement such as nurse staffing committees or councils, as well as anonymous surveys to illicit their feedback. This finding, coupled with the rise of nurse staffing committee legislation in the United States, spurred me to investigate the phenomenon of nurse staffing committees (NSCs).

Seeking out staff nurse perspectives on staffing committees.

Although there is limited research on the impacts of NSCs, researchers have identified non-significant changes in RN hours per patient day in states with NSC policy compared to those without NSC policy, suggesting that NSCs are not thus far making a great impact in terms of improving staffing levels.But in reviewing the limited qualitative literature on NSCs, I noticed a lack of recent work or work that focused solely on the perspectives of staff nurses. The driving force behind NSCs is to involve staff nurses in decision-making to improve staffing and patient care processes. It seemed ironic to me that the main players of NSC policy and practice did not have a study that just focused on their experiences.

Of course, the perspectives of hospital and nursing leadership are important as we explore this phenomenon, but those groups already have more decisional power in hospital organizations than direct-care staff nurses, and it is also easier to elicit those perspectives. Staff nurses can determine when care situations become unsafe for themselves or their patients, making them critical informants for staffing decision-making. For all the above reasons, I wanted to explore the experiences of nurses who served on NSCs and understand how these committees worked.

Honoring nurse perspective and insight.

In the study, ‘A Real ‘Voice’ or ‘Lip Service’? Experiences of Staff Nurses Who Have Served on Staffing Committees, nurses expressed a need for mechanisms for decisional power, to feel that their perspectives and the evidence on the importance of nurse staffing were valued, and to see efforts that indicated their recommendations were honored in the committees. Otherwise, the committee’s existence and recommendations could feel like ‘lip service,’ a token effort that didn’t bring meaningful change.

Several participants also alluded to connections between safer, high-quality nursing services; nurses’ well-being; and the way committees provide opportunities to highlight the nurse–patient relationship from a systems perspective. While there are several policy and practice implications from this study, the overarching theme revolves around valuing and honoring staff nurse perspectives on staffing issues in order improve patient care, retain nurses in their roles, and improve hospital systems.

Nurses are leaving or considering leaving hospital systems in droves, citing inadequate staffing and not feeling listened to as key reasons. If we truly wish to pursue positive, equitable patient outcomes, then we must also prioritize the well-being and work environments of nurses and actively engage them in the staffing decision-making process.

Marissa P. Bartmess, PhD, RN, is clinical assistant professor at the College of Nursing, University of South Carolina, Columbia. 

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